**limpetfan**

hootie123

Hey - I'm working on my list of questions for my RE for my WTF.  I was wondering if you discussed or are having any additional b/w or tests (other than metformin).   I've been doing a lot of research about repeat failed IVFs - and I'm finding some interesting things.  I read some info about doing an endometrial biopsy the cycle before the IVF transfer - and it seems to help with implantation.   Also I'm wondering if we should do a hysterscopy to see if there is something in the uterus that they could not see otherwise.  My other thoughts are getting b/w for immune issues or repeat loss (even though I've never had a loss - I don't want to wait until I do to get b/w for it).  I figure it can't hurt to have more information - and I might as well get it done while I am waiting to cycle again.   If my current RE doesn't think any of this is necessary I'll just ask the new RE anyway.  Thoughts - or anything else I should ask about (other than WTF happened?)?   

limpetfan

Oh, I had a HUGE list of issues to raise with my RE!!  I'm happy to share

Unfortunately, I left my big notebook of notes and questions, etc. at home today, but off the top of my head, here's what I discussed with my RE at my last WTF:

1) Do I need a medication with less LH? I had done a lot of research that suggested too much LH = bad when you have PCOS, and switching to low-LH medications like Bravelle can improve egg quality.  My RE thought this was a load of crap, though.  

2) We knew my egg quality was pretty craptastic for both IVFs, so I asked what would be causing that.  There had been issue raised about maybe I was DOR (I'm not), so I asked about that, and about supplements for improving egg quality like DHEA (bad if you're PCOS, though), inositol, and Metformin.  I'd ask if they have any notes from the embryologist about what your eggs actually looked like when they were collected -- that told my RE a lot about why my cycles are failing.

3) I asked for both DH and I to be karyotyped.  Even though I've never had a loss, I figured it was worth having this test done to make sure we don't need to worry about PGD next time.  My RE agreed -- and it turns out, we both have perfectly normal chromosomes, so PGD is probably not worth the money for us right now.

4) I asked if I should have a lap/hysteroscopy/any other tests to make sure there is no other issue.  My RE felt that was totally unnecessary since our issue appears to be one of egg/embryo quality, not of implantation.  

5) I asked about immune testing, which my RE also felt was unnecessary at this point.  However, if I do IVF again, and it doesn't work again, I will probably ask a new RE to do immune testing, just to be sure.

6) I asked about further sperm testing - especially chromatin fragmentation.  My RE was against this test because we did ICSI and had fantastic fertilization rates, which suggested to her the issue is more linked to bad eggs than bad sperm.  My DH is going to a urologist this week to see if a specialist has a different opinion on the sperm morphology/fragmentation testing issue (he's going for other reasons, too, though).

7) I asked about endometrial biopsy and co-culture of the embryos, which is not something my clinic will do.

8) I asked if we are candidates for assisted hatching.  The answer to that was, if we were doing 3-day transfers, they would be automatically using AH, but we always try for 5-day transfers, and they don't do AH on blastocysts.  

9) I asked if we should be looking at a 3-day transfer instead of a 5-day... but we all concluded 5-day is better, even though our embryos suck by day 5.

My RE was the one who came up with the Metformin idea, and she had a whole diagram/explanation for why I should give it a chance even though I'm not IR.  It was very convincing.  

It NEVER hurts to ask questions and pursue testing that will give a better picture of what's going on, in my opinion.

If I remember anything else, or see I left something vital out when I get home to my notebook, I will let you know!  I hope that helps -- if you want more info on any of this stuff, feel free to ask

 

 

hootie123

THANK YOU SO MUCH!!!   This was really helpful.  I also have my notebook at home - I was just writing out my thoughts on sticky notes this morning (so much for work!).   It will be interesting to compare notes as to what my RE says this week. 

Check out this research on the endometrial biopsy - its not for co-culture - it was just done to stimulate the lining for the next cycle for people with previous failed IVFs.   I thought it was interesting -

https://www.jhrsonline.org/article.asp?issn=0974-1208;year=2010;volume=3;issue=1;spage=15;epage=19;aulast=Narvekar

Its more of a question for my new RE though - since they will be doing the next one.

limpetfan

No problem -- and you're doing exactly what I did between negative beta and WTF appointment! I had sticky notes everywhere... it's why I got a notebook   No one can accuse us of not doing our due-diligence!  I'm definitely curious to hear about what your RE says at your appointment.

The biopsy article is really interesting!  If I was capable of making good quality embryos, I'd be all over the idea.  I wish I had saved the article my RE's office gave me at my last retrieval because I'd send it to you - it was about how laser acupuncture prior to transfer has been shown to increase implantation by 5%.  I'm definitely doing that before our next transfer!

I think it's amazing how much the ovarian microenvironment can mess around with IVF outcomes, too.  And it's crazy to look at the feedback loops and hormonal cascades that affect that microenvironment.  Sometimes it seems like everything you do can crap up your chances.  *sigh*